As Oct. 1 and the beginning of enrollment on the public health insurance exchanges gets close to arriving, the outlook for the exchanges has gotten a little murkier when examining them from certain perspectives.
Back in June, I was relatively optimistic about how the rollout of the exchanges would unfold, standing on the admittedly unscientific platform of strong relative performance by hospital stocks. At the time, hospital stocks were on a roll and the outlook was fairly good. My thoughts then were that if the stock market is bullish on hospitals, it must also be on health care reform.
Since then, that platform for the most part has collapsed, with many publicly traded acute-care hospital stocks down during the three months ended Sept. 3 at a time when the rest of the market was essentially flat. With the exception of acquisition target Vanguard Health Systems, hospital stock prices were all down: from negative 1.8 percent to negative 18.8 percent.
From a financial health perspective, analysts for a major not-for-profit hospital debt ratings agency currently don't see signs that the exchanges will be a great success or a great failure.
The debt ratings agency is expecting a modest impact, and is not predicting whether it will be a positive or negative for hospitals, says Lisa Goldstein, associate managing director for Moody's, whom I was interviewing for an upcoming H&HN story.
"We're going to watch the enrollment," but at this stage indicators hint that the number of people signing up will be relatively modest, which means there likely won't be a significant revenue benefit to hospitals, Goldstein says.
Ideally, people without health insurance will sign up for coverage on the exchange and they will be able to afford the deductibles and co-payments. But Moody's analysts are not counting on that.
"We are not expecting big declines in uncompensated care for hospitals," she says. "Bad debt will still exist."
And as my colleague Matthew Weinstock pointed out last week, there are signs that enrollment could be weak, at least initially, because not many people know whom the exchanges are for or how they work.
Yet, none of this is enough for me to change my opinion that ultimately the exchanges will succeed, if not thrive. Yes, October could be difficult given the newness of it all. But the six-month enrollment period should be enough time to get the kinks out and fix any parts that are broken. And the Obama administration is likely to pull out all stops to ensure the exchanges work, given how much effort has already been put into them.